Although injection and aspiration of soft tissues and joints is a mainstay in the therapy of rheumatic diseases, surveys of training programs have continually shown that medical trainees are not able to practice these procedures with sufficient repetition and supervision to become technically proficient. Most physicians, therefore, have to learn these important procedures in a very sub-optimal fashion by practicing on their patients in an unsupervised environment once they are in the community. To address this and other lack of training opportunities in medical procedures, Touch of Life Technologies, Inc. is pioneering the creation of virtual reality based simulators, among which is the Virtual Reality-based Joint Injection Simulator (VR-JIS). The VR-JIS offers a virtual knee or shoulder combined with haptically enabled virtual palpation, virtual syringe, and simulated ultrasound to create an environment for structured and monitored practice of joint injection procedures. The VR-JIS includes a Mentor program that provides instruction, guidance, and testing. Solutions to all technically challenging aspects of the Mentor and simulator combination have been demonstrated during the phase I effort. In this phase II effort, the system will be matured to a production system ready for standalone use in training programs around the world. The specific aims of the phase II effort to accomplish this are: 1) Add a wide and relevant range of pathologies including varying size potential spaces, 2) Refine the Mentor/Simulator to seamlessly control all relevant states of the simulation, 3) Create a complete curriculum of needle procedures relevant to the knee and shoulder, and 4) Validate the efficacy of the resulting system. This effort will develop a computer-based system for practicing needle insertion techniques for joints. The system is designed to reduce the trainee's dependence on patients as training devices. [unreadable] [unreadable] [unreadable]